During surgical procedures, tissue and membrane fixation and approximation are often necessary. Various types of surgical fastening devices are used for accomplishing such functions. Some conventional fastening devices include, for example, sutures, staples, screws, clips and anchoring devices.
Sutures are generally used in tissue approximation. However, sutures require significant skill for precise placement and, if multiple closures are required, are time consuming to apply. Additionally it is often not possible to use sutures to approximate tissue and membrane located inside many tight areas of the body. Staples generally are used to repair large areas and typically require minimal precision in their placement. Clips are typically used in endoscopic and laparoscopic closure or ligation of vessels.
Some fasteners having a generally tack-like structure have been developed. Said fasteners are disclosed in, for example, U.S. Pat. Nos. 4,873,976; 5,059,206; 5,246,441; 5,376,097; 5,562,704; 5,827,298; and 5,843,084.
Such tack-like structures generally comprise a shaft, a front portion and a back base portion. Additionally, each structure further comprises a type of barb-like or arresting means along the body to aid in holding the structure within the body. The focus of use of these tack-like structures is generally for repairing the meniscus. Thus, these tack-like structures are relatively large, with lengths ranging from about 0.2-0.64 inch and diameters ranging from about 0.04 to 0.07 inch. Further, they are designed to either have a significantly rigid shaft for insertion into the tough meniscal area or they are inserted while held within a penetrating tool having a sharp or pointed leading edge. In the situation where a penetrating tool is used, the tool cuts through the tissue and the tack-like fastener is carried through the tissue by the tool, and deposited in the tissue. This is disadvantageous in part because the tool which carries the tack must be larger than the tack. This leads to a larger cut within the tissue than necessary, and an increase in trauma to the area. Additionally, when the fasteners have barb means or arresting means protruding from the shaft, the tool must accordingly be made even larger to house the barb-like or arresting means. Alternatively, where the barb means or arresting means protrude outside of the tool or where no tool is used, the barb-like or arresting means make cuts in the tissue as the tack-like fastener is inserted, thereby increasing trauma to the area.
There is a need for surgical fastening devices that are quickly applied and are suitable for small tissue approximation in situations requiring multiple points of connection and fine precision. Due to the nature of such tissue repair, small and relatively flexible surgical fasteners are needed. For example, surgical repair of cartilage involves the affixation of a temporary covering, such as the periosteum, to a portion of cartilage. Small and flexible fasteners are required for the fixation of the delicate and thin covering to the generally thin underlying cartilage, and the fasteners must be inserted close to the edges of the covering without tearing through the edges of the covering. Accordingly, there is also a need for a method of handling small sized, flexible fasteners for proper alignment and insertion into the body. Additionally, there is a need for surgical fastening devices and methods that may be used to approximate tissue and membrane or other tissue located in tight areas inside of the body. Further needed are surgical fastening devices and methods of inserting the surgical fasteners to minimize trauma to the area during insertion.